A definition of “flare” in low back pain

a multiphase process involving perspectives of individuals with low back pain and expert consensus

Nathalia Costa, Manuela L. Ferreira, Jenny Setchell, Joanna Makovey, Tanya Dekroo, Aron Downie, Ashish Diwan, Bart Koes, Bard Natvig, Bill Vicenzino, David Hunter, Eric J. Roseen, Eva Rasmussen-Barr, Francis Guillemin, Jan Hartvigsen, Kim Bennell, Leonardo Costa, Luciana Macedo, Marina Pinheiro, Martin Underwood & 8 others Mauritus Van Tulder, Melker Johansson, Paul Enthoven, Peter Kent, Peter O'Sullivan, Pradeep Suri, Stephane Genevay, Paul W. Hodges*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Low back pain (LBP) varies over time. Consumers, clinicians, and researchers use various terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although “flare” is use commonly, there is no consensus on how it is defined. This study aimed to obtain consensus for a LBP flare definition using a mixed-method approach. Step 1 involved the derivation of a preliminary candidate flare definition based on thematic analysis of views of 130 consumers in consultation with an expert consumer writer. In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions. Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in musculoskeletal conditions. The definition favored by experts was further tested with 16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase study produced a definition of LBP flare that distinguishes it from other LBP fluctuations, represents consumers’ views, involves expert consensus, and is understandable by consumers in clinical and research contexts: “A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions.” 

Perspective: A multiphase process, incorporating consumers’ views and expert consensus, produced a definition of LBP flare that distinguishes it from other LBP fluctuations.

Original languageEnglish
Pages (from-to)1267-1275
Number of pages9
JournalJournal of Pain
Volume20
Issue number11
Early online date21 Mar 2019
DOIs
Publication statusPublished - Nov 2019

Keywords

  • Low back pain
  • flare
  • flare-up
  • definition
  • consensus

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